PA = Prior Authorization is required;
QL = Quantity limits apply;
ST = Step Therapy applies;
RD = Specialty Formulary, please refer to Specialty Pharmacy Program section for additional information;
OTC = Over-the-counter Product, may be covered if a prescription is written, and it is filled at a retail or mailorder pharmacy
Medications written in all CAPITAL letters are Brand names.
Medications written in all lower case letters are available generically. The brand name is listed in parenthesis for reference only.
UULTRASE MT
urea (Carmol, Kerol, Kerol ZX)
UROXATRAL,
males only URSO FORTE
ursodiol (Actigall, Urso)
V
VALCYTE
valproic acid (Depakene)
VALTREX,
QL VANCOCIN
velivet (Cyclessa)
VELOSULIN BR,
OTC venlafaxine (Effexor)
VENTOLIN HFA
verapamil (Calan)
verapamil extended-release (Calan SR, Verelan PM)
VESANOID
VFEND,
MDVIGAMOX
VIMPAT,
QLvinatal forte (Natafort)
VIRA-A
VIRACEPT
VIRAMUNE
VIREAD
visqid a/a (Uroqid-Acid No. 2)
VIVELLE-DOT,
QLVYTORIN
VYVANSE
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